Practice Management Alert

Electronic portals can help you better serve and retain patients, but they still face some challenges.

Patient Portals have incredible potential to improve health care delivery, communication, and outcomes, but they carry some risks and downsides. Jerry Williamson, MD, MJ, CHC, LHRM, a consultant who also teaches at Loyola Law School, gave attendees at the American Health Lawyers Physicians and Hospitals Law Institute an excellent overview of the promise—and peril—of patient portals.

6 Patient Portal Pros

1. Portals can improve communication between patients and providers. Portals have the potential to improve health care by improving communication between patients and their providers, Williamson says. Portals can help reinforce communication between clinicians and patients during clinical encounters, which is sometimes rushed or unclear because the patient is sick or scared.

Patients often hold back during exams and then ask questions about care plans, medications, and follow-ups days and weeks later. A patient portal can help alleviate the stress of this common practice issue and ensure that instructions are accurate and clear.

For example: Let’s say your patient with a chronic care plan needs his lab work data, and it’s June, when you are understaffed due to office vacations. The patient needs access to this quickly for an upcoming appointment and care revisions. Uploading the data to the patient portal eases the burden threefold, says Williamson: it cuts out the need for the traditional phone call by an overwhelmed staff, it reduces the cost by eliminating a physical letter with the results, and the patient gains a better view of their comprehensive data.

2. Portals can improve communication among providers caring for a patient. Portals can also improve communication among caregivers working with one patient. “Every year, the average elderly patient sees seven physicians—five specialists and two primary care providers,” Williamson notes.

Ineffective communication among a patient’s healthcare team is a leading cause of medical mistakes, such as medication errors. It’s such a big patient safety challenge that the 2017 Joint Commission of National Patient Safety Goals lists “improving the effectiveness of communication among caregivers” as its second goal, Williamson says. The Joint Commission works to identify and develop procedures to prevent “sentinel events”—unexpected occurrences “involving death or serious physical or psychological injury, or the risk thereof.”

“Sentinel events” (the word means “soldier” or “guard”) have that name because they signal the need for immediate investigation and response to “guard against” similar events occurring in the future, Williamson explains. The number one root cause of sentinel events between 1995 and 2005 was poor communication, according to a 2007 Joint Commission report. (Interestingly, portals can help with other listed causes for sentinel events, such as availability of information, continuity of care, and care planning.)

3. Portals can improve medical care for chronically ill patients especially.  They can message their doctors with their questions, reducing time on the phone and unnecessary office visits. In one study, portals improved chronic disease management by almost 10 percent, says Williamson, citing a study of Kaiser Permanente of Southern California patients published in the American Journal of Preventive Medicine, July 2016.

Cancer patients in another study used portals four to eight times as much as other patients, says Williamson, citing a July 2014 Journal of Oncology Practice article. Portals are particularly useful for cancer patients tracking lab and radiology results.

4. Portals can improve the accuracy of health records:  Patients or their caregivers can more easily identify any mistakes or omissions in the medical record.

5. Portals improve patient engagement because they empower patients to be active participants in their medical care. Having the medical record available all the time—and not just when visiting the office—equips the patient to participate more fully with medical decision-making and progress. They are more likely to learn about their conditions and advocate for themselves, says Williamson, citing a study of the VA’s MyHealtheVet portal, which was published in the Journal of Medical Research in March 2013.

“While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits,” researchers note in the JAMR article.

Important: The same researchers note that giving patients online access to clinical notes doesn’t increase workload in the clinic, but may require clinicians to learn “new types of skills to communicate and partner with patients.”

6. Portals encourage patient loyalty. A recent study by health care IT vendor athenahealth found that the retention rate for patients who signed up for a portal was 80 percent, as opposed to 67 percent among those who didn’t sign up. Again, it’s not the technology itself that improves relationships between patients and providers. It’s that the technology facilitates good communication about patient care.

4 Patient Portal Cons

1. Portals present PHI security challenges. There are many ways for cyber criminals and identity thieves to hack into systems containing PHI, and a portal is just one more way for them to get in. Educating your patients on PHI security and choosing a portal that encourages good security habits is crucial, says Williamson.

Many providers never consider the HIPAA security risks of portals, Williamson adds. They sign agreements with vendors without much thought or any professional legal input. Two contracts are needed:

1. a vendor contract, and
2. a Terms of Use contract with the patient.

Many providers are omitting these precautions, and that is poor risk management.

2. Some providers are reluctant to use portals. Most providers first began to hear about portals during the first days of Meaningful Use—a federal initiative so reviled that many providers called it “Meaningless Use.”

For this reason, some clinicians may perceive portals as bureaucratic and time-consuming—just one more meaningless, top-down administrative task the government is forcing them to do. They worry that portals will generate more work for them and will confuse patients—especially their patients in vulnerable populations, according to a study published in the Journal of Medical Internet Research in January 2016.

3. Patients don’t register for portals and use them as much as they might. “Multiple case studies have shown that if the patient isn’t registered in the hospital or the clinic when they first see the physician, then they are less likely to register for the portal on their own,” Kenneth Ong, MD, MPH (recently retired as Chief Medical Informatics Officer for New York – Presbyterian Hospital in Queens) tells Practice Management Alert. “The staff also has to be trained so that they can share with the patient how useful the portal can be.” As a result, some practices now automatically sign patients up for the portal, bypassing the opt-in.

4. A lack of interoperability still plagues portals. EHR companies are sharing data and connecting providers more readily than in the past, but systems aren’t yet fully interoperable and few patients have their PHI stored all in one place. As a result, many patients access PHI from multiple portals supplied by multiple providers, which is tedious. “It’s vital to merge patient data into one place,” says Ong, “so that providers as well as patients can see the reality of their issues and medications, and so they don’t have five or six different versions of their medical history.”

Fortunately, there is some hope on the horizon: FHIR (Fast Healthcare Interoperability Resources) is a technology standard designed “to aggregate different data from different EHR vendors,” says Ong. A definitive version of FHIR is expected from Health Level Seven International in 2017, giving providers hope of much greater interoperability going forward. The ability to more easily share medical data in order to let patients and providers see everything in one place could truly improve ease and quality of care.